MP-453085-11 ALLIED PROFESSIONALS DISPOSITION PATHWAY WITH CONDITIONAL DISCHARGE REDUCES BED UTILIZATION AND HOSPITAL RESOURCES

Abstract

Increasing demands of inpatient level of care continue to pose challenges to hospital resources and available capacity. Alternative disposition pathways overseen by allied professionals (AP) that utilize extended recovery unit (ERU) hours and conditional discharge (CD) can reduce inpatient bed use, total time spent at the hospital and overall resource utilization. To demonstrate that implementation of disposition pathways utilizing CD and same day discharge (SDD) with an ERU reduces hospital resources without compromising patient safety. An ERU was created to reduce inpatient hospital bed utilization and optimize disposition pathways. This unit included 6 patient beds, 2 registered nurses and overnight coverage. Patients (pts) presenting for elective electrophysiology procedures were classified into three different disposition pathways including SDD, CD and admission to EP allied professional (EP AP) service. All 3 pathways were overseen by EP APs. Pts in the SDD and CD group were required to meet specific criteria noted by the AP to be considered safe for discharge. We compared these new pathways with prior disposition orders in relation to efficiency, safety and resource utilization. From 8/28/2022 to 11/13/2022, 918 pts presented for an EP procedure including cardiac device implantation and ablation. Of these, 200/918(21.8%) were eligible for our disposition pathway. There were 74(8.1%) pts who were SDD, 51(5.6%) pts in the CD pathway, 61(6.6%) pts admitted to the EP AP service, and 14(1.5%) pts were cross-over pathways (failed CD transitioned to EP AP service). The remainder were either already inpatient or felt pre-procedure to require inpatient level of care. Pts evaluated on the EP AP service in the ERU had an average discharge time of 10:04AM vs 12:53PM for pts on the EP AP service admitted to an inpatient unit. Patients in the CD group located in the ERU had an average discharge time of 7:49AM. Discharge time with these pathways improved over time (Figure 1). The total number of pts admitted to the ERU and/or discharged the same day was 186 pts, indicating 186 total hospital beds saved. There were no differences in overall complications between disposition groups compared to prior to implementation of this strategy. The implementation of a disposition pathway strategy utilizing SDD, CD and an ERU overseen by APs is associated with reduced resource utilization without compromising pt safety.